Impact of parenchymal transection techniques on intraoperative blood loss during liver resection in a porcine model of elevated central venous pressure: A comparative study
Introduction and Objectives: Liver resection is the standard treatment for resectable liver tumors and metastases. However, mortality and morbidity remain significant concerns, particularly for patients with chronically elevated central venous pressure (CVP), which increases perioperative complicati...
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Elsevier
2025-01-01
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| Series: | Annals of Hepatology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268125000110 |
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| author | Felicia Kneifel Annika Mohr Alexander D. Bungert Tristan Wagner Mazen Juratli Haluk Morgul Finnja Marie Krug Tim-Gerald Kampmeier Christian Ertmer Andreas Andreou Philipp Houben Shadi Katou Andreas Pascher Benjamin Strücker Felix Becker |
| author_facet | Felicia Kneifel Annika Mohr Alexander D. Bungert Tristan Wagner Mazen Juratli Haluk Morgul Finnja Marie Krug Tim-Gerald Kampmeier Christian Ertmer Andreas Andreou Philipp Houben Shadi Katou Andreas Pascher Benjamin Strücker Felix Becker |
| author_sort | Felicia Kneifel |
| collection | DOAJ |
| description | Introduction and Objectives: Liver resection is the standard treatment for resectable liver tumors and metastases. However, mortality and morbidity remain significant concerns, particularly for patients with chronically elevated central venous pressure (CVP), which increases perioperative complication risks. The optimal parenchymal transection technique for these patients remains unclear, necessitating further research. Materials and Methods: This study established an innovative porcine model for high-CVP liver resection. Animals were divided into two groups: a control group (CVP ≤ 5 mmHg, low-CVP) and an intervention group (CVP ≥ 10 mmHg, high-CVP). A left lateral liver resection was performed using three parenchymal transection techniques: clamp-crush (CC), harmonic scalpel (HS), and stapler (ST). The primary endpoint was intraoperative blood loss, while secondary endpoints included transection time and bile leakage. Results: No differences were found for blood loss or transection time among the low-CVP subgroups. In the high-CVP group, the HS and ST techniques were associated with significantly reduced blood loss and faster transection times than the CC technique. While transection times for the HS and ST were similar between the low- and high-CVP groups, they were significantly longer with the CC technique in the high-CVP group. The incidence of bile leakage was comparable across all three techniques. Conclusions: This pilot study demonstrates superior outcomes for HS and ST techniques in high-CVP liver resections. Insights from this large animal model provide a basis for investigating optimal transection techniques for chronically elevated CVP, bridging preclinical research and clinical practice. |
| format | Article |
| id | doaj-art-fa9b2e2eb9d346218ebc5ebb6e0e0a80 |
| institution | DOAJ |
| issn | 1665-2681 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
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| series | Annals of Hepatology |
| spelling | doaj-art-fa9b2e2eb9d346218ebc5ebb6e0e0a802025-08-20T03:18:27ZengElsevierAnnals of Hepatology1665-26812025-01-0130110178710.1016/j.aohep.2025.101787Impact of parenchymal transection techniques on intraoperative blood loss during liver resection in a porcine model of elevated central venous pressure: A comparative studyFelicia Kneifel0Annika Mohr1Alexander D. Bungert2Tristan Wagner3Mazen Juratli4Haluk Morgul5Finnja Marie Krug6Tim-Gerald Kampmeier7Christian Ertmer8Andreas Andreou9Philipp Houben10Shadi Katou11Andreas Pascher12Benjamin Strücker13Felix Becker14Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, GermanyDepartment of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, GermanyDepartment of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, GermanyDepartment of General, Visceral, Cancer and Transplant Surgery, Faculty of Medicine and University of Cologne, Cologne, GermanyDepartment of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, GermanyDepartment of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, GermanyDepartment for Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, GermanyJosephs-Hospital Warendorf, Department of Anesthesiology, Intensive Care and Pain Medicine, Warendorf, GermanyDepartment for Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, GermanyDepartment of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, GermanyDepartment of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, GermanyDepartment of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, GermanyDepartment of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, GermanyDepartment of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, GermanyDepartment of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany; Corresponding author.Introduction and Objectives: Liver resection is the standard treatment for resectable liver tumors and metastases. However, mortality and morbidity remain significant concerns, particularly for patients with chronically elevated central venous pressure (CVP), which increases perioperative complication risks. The optimal parenchymal transection technique for these patients remains unclear, necessitating further research. Materials and Methods: This study established an innovative porcine model for high-CVP liver resection. Animals were divided into two groups: a control group (CVP ≤ 5 mmHg, low-CVP) and an intervention group (CVP ≥ 10 mmHg, high-CVP). A left lateral liver resection was performed using three parenchymal transection techniques: clamp-crush (CC), harmonic scalpel (HS), and stapler (ST). The primary endpoint was intraoperative blood loss, while secondary endpoints included transection time and bile leakage. Results: No differences were found for blood loss or transection time among the low-CVP subgroups. In the high-CVP group, the HS and ST techniques were associated with significantly reduced blood loss and faster transection times than the CC technique. While transection times for the HS and ST were similar between the low- and high-CVP groups, they were significantly longer with the CC technique in the high-CVP group. The incidence of bile leakage was comparable across all three techniques. Conclusions: This pilot study demonstrates superior outcomes for HS and ST techniques in high-CVP liver resections. Insights from this large animal model provide a basis for investigating optimal transection techniques for chronically elevated CVP, bridging preclinical research and clinical practice.http://www.sciencedirect.com/science/article/pii/S1665268125000110Large animal modelParenchymal transectionCentral venous pressureHepatectomyResection techniques |
| spellingShingle | Felicia Kneifel Annika Mohr Alexander D. Bungert Tristan Wagner Mazen Juratli Haluk Morgul Finnja Marie Krug Tim-Gerald Kampmeier Christian Ertmer Andreas Andreou Philipp Houben Shadi Katou Andreas Pascher Benjamin Strücker Felix Becker Impact of parenchymal transection techniques on intraoperative blood loss during liver resection in a porcine model of elevated central venous pressure: A comparative study Annals of Hepatology Large animal model Parenchymal transection Central venous pressure Hepatectomy Resection techniques |
| title | Impact of parenchymal transection techniques on intraoperative blood loss during liver resection in a porcine model of elevated central venous pressure: A comparative study |
| title_full | Impact of parenchymal transection techniques on intraoperative blood loss during liver resection in a porcine model of elevated central venous pressure: A comparative study |
| title_fullStr | Impact of parenchymal transection techniques on intraoperative blood loss during liver resection in a porcine model of elevated central venous pressure: A comparative study |
| title_full_unstemmed | Impact of parenchymal transection techniques on intraoperative blood loss during liver resection in a porcine model of elevated central venous pressure: A comparative study |
| title_short | Impact of parenchymal transection techniques on intraoperative blood loss during liver resection in a porcine model of elevated central venous pressure: A comparative study |
| title_sort | impact of parenchymal transection techniques on intraoperative blood loss during liver resection in a porcine model of elevated central venous pressure a comparative study |
| topic | Large animal model Parenchymal transection Central venous pressure Hepatectomy Resection techniques |
| url | http://www.sciencedirect.com/science/article/pii/S1665268125000110 |
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